How to know when it's time for a knee replacement

Treating pain in our largest joint

If the simple act of getting out of bed in the morning, climbing a few flights of stairs or going on a brisk walk brings you instant knee pain, you might be concerned … and you also may feel like it’s just a sign that you’re “getting older.”

But chronic knee pain isn’t normal, and it isn’t necessarily a sign of getting older.

A total knee replacement could be the saving grace if you’re experiencing severe pain in the body’s largest joint, as well as trouble with range of motion, function and stability. But how do you know if the procedure is right for you, and what can you expect?

“The good news is that modern technology means these surgeries aren’t your grandmother’s knee replacement,” said Dr. John Doherty, an orthopaedic surgeon at Geisinger Orthopaedics and Sports Medicine in Scranton. “Thanks to robot-assisted surgery and other new tactics, patients are experiencing better results with less scarring and downtime.”

Here’s what you need to know about knee replacements.

Why do knees fail?

Osteoarthritis, a disease that causes the breakdown of cartilage cushioning the joints, is the most common reason patients seek a knee replacement. Long believed to be just “wear and tear” on the joints because of its disproportionate effect on older people, studies have since confirmed that it’s a disease marked by inflammation and deterioration.

“People who are overweight or obese may also be susceptible to chronic knee pain and deterioration, as well as those who work in labor industries or were involved in a traumatic event affecting the lower body,” said Dr. Doherty.

What are the warning signs?

If you experience severe knee pain both during activity and at rest and decreased range of motion and stiffness that doesn’t go away after non-surgical treatment, you may be a candidate for knee replacement surgery.

You may also notice visible signs of a failing knee, including a bulge or inward bow.

Are there nonsurgical treatment options?

Before discussing knee replacement, your doctor may prescribe an anti-inflammatory over-the-counter pain medication such as ibuprofen or naproxen to help with pain and reduce swelling. Cortisone, a steroid hormone, may also be injected into the knee to relieve pain.

You might also want to try glucosamine or chondroitin sulfate, common supplements containing material found in the joints, which help with regeneration.

Losing weight, thanks to changing your diet and exercising more, also have a positive effect on the joints. Our knees receive four pounds of pressure for each pound of body weight, giving even a slight reduction considerable impact. Beyond that, the increased strength and mobility from exercise can reduce pressure.

How does a knee replacement work?

A total knee replacement surgery can take from one to three hours. During that time, an orthopedic surgeon will remove damaged cartilage and bone before fitting the replacement joint, called an implant, with help from the latest robotic-assisted technology.

Using this device, your surgeon can pre-plan the procedure and get the most accurate measurements, ensuring that your implant is perfectly fitted. It also helps with bone resurfacing and the removal of cartilage.

Implants come in a variety of different designs created by different manufacturers, but will always contain metal and plastic components that fuse to the resurfaced bone.

“Your orthopedic surgeon will select the design that best fits each patient based on their lifestyle habits and the severity of the biological joint’s deterioration,” said Dr. Doherty.

Is this a permanent fix?

More than 90 percent of people with modern knee replacements have maintained good function more than 15 years after the surgery. However, replacement joints experience wear and tear similar to biological joints and should be cared for accordingly.

Maintaining a healthy lifestyle and making regular doctor’s visits will keep you on track.

How do I know if a knee replacement is right for me?

Chronic knee pain isn’t normal. If you experience constant pain, you should talk to your doctor. They may recommend X-rays to confirm bone deformities or deterioration, and an MRI to diagnose issues with soft tissue.

“Though total knee replacements are typically a very successful surgery, it’s important to recognize the potential risks and drawbacks for certain patients,” said Dr. Doherty. “I encourage patients to speak openly about pain levels and physical limitations with their doctor to confirm your best treatment options.”

John Doherty, MD, is an orthopaedic surgeon specializing in hip and knee surgeries at Geisinger Orthopaedics and Sports Medicine in Scranton. To schedule an appointment, call 800-275-6401.